Facts
The Swedish Sport Confederation (Riksidrottsförbundet, RF) charged Pontus Dolfei, the athlete, for a violation of the Anti-Doping Rules. The athlete had tested positive for Cocaine (S6a) and THC (S8) on October 5, 2014. Which are prohibited substances according the World Anti-Doping Agency (WADA) 2014 prohibited list.

History
The athlete had been provisionally suspended since November 10, 2014.

Decision
The sanction is a period of ineligibility of 30 months from November 10, 2014 until May 9, 2017.

Årsberättelsen 2020 / Riksidrottsförbundet (RF) - Swedish Sports Confederation. - Stockholm, 2021

Facts
The Rugby Football League (RFL) charges Amdrew Brocklehurst (player) for a violation of the Anti-Doping Rules. The player provided an urine sample during an in-competition doping test on 28 June 2009. The examination of that sample showed the presence of ephedrine and benzoylecgonine (a metabolite of cocaine). Both are Prohibited Substances. This matter was determined on the documents without an oral hearing.

History
The operations manager of the RFL, explained by e-mail that the player had used cocaine socially but he has no idea how the ephedrine got into his system.

Considerations tribunal
The player didn't contest the charge, which entitles the tribunal to impose a period of two years of ineligibility.

Decision
1. A doping offence contrary to article 3.2.1 of the of the Anti-Doping Rules of the Rugby Football League has been established;
2. Mr Brocklehurst shall have imposed on him a period of ineligibility of 2 years, commencing on 21 July 2009 and expiring at midnight on 20 July 2011.

Appeal
An appeal can be made 21 days after receiving the decision.

Rifampicin for Treatment of Cholestatic Pruritus Caused by Drug-Induced Acute Liver Injury as Assessed by the RUCAM Classification / Ali R. Ahmadi, Maria Chicco, Marcel van den Berge. - (Case Reports in Hepatology (2020) 872804 (8 August); p. 1-5)

• PMID: 32832174
• PMCID: PMC7429806
• DOI: 10.1155/2020/8872804

Abstract

A male bodybuilder of 39 years of age developed severe pruritus, nausea, and jaundice after injecting anabolic steroids purchased on the black market. The patient had no history of liver disease and no risk factors for viral hepatitis. Extensive laboratory testing, radiographic imaging, and liver biopsy excluded a majority of potential pathologies. The patient was diagnosed with drug-induced acute liver injury and secondary acute renal failure most likely caused by testosterone purchased on the black market. The pruritus caused insomnia and significant psychological distress. Treatment was initiated with cholestyramine and naltrexone for one week with no effect on the pruritus. Subsequently, all medications were stopped, and rifampicin was started. Pruritus resolved after starting rifampicin, and liver and kidney function improved rapidly and normalized within 5 months.

Risk and enabling environments in sport : Systematic doping as harm reduction / April Henning, Katherine McLean, Jesper Andreasson, Paul Dimeo

• International Journal of Drug Policy 91 (2021) 102897 (May)
• PMID: 32768155
• PMCID: PMC7402240
• DOI: 10.1016/j.drugpo.2020.102897

Abstract

Doping and the use of performance enhancing drugs (PEDs) are often considered and discussed as a separate issue from other types of substance use, by sporting bodies, politicians, the media, and athletes who use drugs themselves. However, perceptions and understandings of substance use in the sport and fitness world are directly related to those of substance use in the non-sport world. One way the gap between sport and non-sport substance use research can be bridged is to consider sport risk and enabling environments. Similar to non-sport contexts and drug use, it is important to analyse the environments in which doping occurs. This approach allows us to examine the dynamic interplay between risk and enabling factors, as the enabling environment shifts in response to changes produced in the risk environment, and vice versa. There are models of sport environments that have proven effective at both enabling doping by athletes and reducing harms to athletes: systematic doping. This article will use secondary literature in order to review and analyse known cases of systematic doping through the risk and enabling environment frameworks. We argue that these systems responded to anti-doping in ways that protected athletes from the risk factors established by anti-doping policy and that athletes suffered most when these systems were revealed, exposing athletes to the full range of doping harms. Further, we argue that risks within these systems (i.e. extortion, bullying) resulted from the broader prohibitive sport environment that forces doping underground and allows such abuses to occur.

Risicogedrag bij het online bestellen van geneesmiddelen (Dutch title)

Intomart GfK has, by order of the Dutch Ministry of Health, Welfare and Sport, conducted a quantitative research in early 2009, and a second wave in October 2012.

The aim of the re-search is to gain insight in the target group of people who have purchased medication on-line or who consider doing so (‘considerers’). This research provides insights in the background details of on-line purchasers and developments in their motives, behavior, risk perception and need for information.

Profile people purchasing and considering on-line purchase 13% of the of the adults (18+) indicate, in Autumn 2012, ever having purchased medication on-line. A further 6% of the adults have at some point in time considered purchasing medication on-line.

On-line medication is often purchased without a doctor’s prescription. The percentage of Dutchmen that have purchased medication on-line without a prescription at some point in their lives increased from 3% in 2009 to 11% in 2012. Dutchmen who do not purchase medication on-line are, on average, older and tend to have a slightly lower level of education than those who do. Female consumers buy medication on-line slightly more often than male consumers.

The prime motive for purchasing medication on-line is convenience; the possibility to order out-side office hours and home delivery are considered great advantages. The motives for not buying medication on-line are widely divergent, but mostly concern lack of clarity of the information.

Purchase behavior
On-line medication is often purchased without a doctor’s prescription (ranging from 30% for antibiotics to 96% for diet pills). Usually people do not consult their doctor when considering the on-line purchase of medication. However, people do have a need for information, and they often look for it on the internet.

Although more and more Dutchmen order medication on-line, the frequency of the purchases has decreased. Medication is bought on-line rather occasionally. For ordering medication, people usually go to Dutch websites. Customer satisfaction with the medication ordered is high, as is the willingness to promote the on-line purchase of medication to others; over half of the customers (55%) would recommend others to buy their medication on-line. This especially holds true for contraceptives and painkillers.

Satisfaction with on-line purchase is lowest for hypnotic medication, anti-smoking medication and diet pills. The most common reasons for dissatisfaction are the lack of improvement of sleep, failure to quit smoking or insufficient weight loss.

Risk perception
People who have purchased medication on-line and considerers are to a large degree aware of the risks involved. Two in three buyers and considerers acknowledge that control by a pharmacist’s may be lacking, and the composition of a product may be different. More than half of the customers know that the Patient Information Leaflet (PIL) may be missing or is unclear, or that the product has the wrong label.
Even though buyers and considerers are equally aware of the different risk factors associated with the on-line purchase of medication, there is a difference between these two groups in the perception of the magnitiude of the risks these pose for one’s health. For example, buyers estimate the risk of on-line medication being falsified at 28%, whereas considerers estimate this risk at 52%.

Buyers are aware of the risks but think they can manage them, and therefore they purchase their medication on-line. Considerers are more cautious. The greatest perceived risk is the lack of checks on possible side effects due to interactions with other medication. However, the other risk factors are estimated as being at an almost equally high level. The risks of side effects due to interactions can be brought to the attention of people currently already using other medications. For people currently not using any medications, this message will have no deterrent effect whatsoever.

Need for information
Considerers often have a higher demand for information than buyers (buyers: 31%, considerers: 43%). The need for information has, in 2012, increased somewhat since the previous wave of 2009. On-line buyers of medication who seek information about ordering medication on-line safely, mostly declare to do so via their regular pharmacy. The primary source of information to considerer is the internet. The Dutch Ministry of Health uses the website internetpillen.nl, along with other sources, to provide buyers and considerers with information about, for example, how to identify suppliers of counterfeit medication and how to order medication on-line safely. The website is mostly unknown, with only 3% awareness amongst buyers and 2% amongst considerers. The target audience either does not find its way to, or does not remember, the website.

Opinions vary widely about which would be the most obvious source of information about safely purchasing medication on-line. There are several credible parties that could provide the information. Buyers seem to have a slight preference for their regular pharmacy, while considerers prefer the general practitioner. Both groups also name the Ministry of Health and the RIVM (the National Institute of Public Health and Environment of the Netherlands) as obvious providers of the information.

Conclusions
More and more Dutchmen order their medication on-line, often without consulting a physician. To a large degree they are satisfied with the delivered product, and recommend it to others. In light of the high degree of satisfaction among a large group of Dutchmen, it can be expected that the on-line purchase of medication will increase further, and will even become widely accepted, in the years to come.
Even though on-line buyers of medication are aware of the risks involved with the on-line purchase of medication, they are confident that they are capable of assessing a provider’s trustwor-thiness. The lack of any check on possible side effects due to interactions with other medication is considered the greatest risk. The risks of side effects due to interactions can be brought to the attention of people currently already using other medications. Buyers see their regular pharmacy as an obvious and reliable source of information, making it the logical choice as a provider of information about the risk of purchasing medication on-line.

Risk factors for anabolic-androgenic steroid use among weightlifters : a case-control study / Gen Kanayama, Harrison G. Pope, Geoffrey Cohane, James I. Hudson. - (Drug and Alcohol Dependence 71 (2003) 1 (20 July); p. 77-86)

• PMID: 12821208
• DOI: 10.1016/s0376-8716(03)00069-3

Abstract

Anabolic-androgenic steroid (AAS) use represents a major public health problem in the United States, but the risk factors for this form of drug use are little studied. We evaluated 48 men who had used AAS for at least 2 months and 45 men who had never used AAS, using a verbal interview and a battery of questionnaires covering hypothesized demographic, familial, and psychosocial risk factors for AAS use. All subjects in both groups were experienced weightlifters; thus, differences between groups were likely to be associated specifically with AAS use, rather than with weightlifting in general. The AAS users and non-users generally described similar childhood and family experiences, but users reported significantly poorer relationships with their fathers and greater childhood conduct disorder than non-users. At the time that they first started lifting weights, AAS users and non-users were similar in their perceived physical, social, and sexual status, but users were significantly less confident about their body appearance. AAS users displayed much higher rates of other illicit substance use, abuse, or dependence than non-users, with use of other illicit substances almost always preceding first use of AAS. These findings suggest that AAS use may be most likely to occur in men with high levels of antisocial traits and low levels of body esteem.

Risk factors for anabolic-androgenic steroid use in men / K.J. Brower, F.C. Blow, E.M Hill. - (Journal of Psychiatric Research 28 (1994) 4 (July-August); p. 369-380)

• PMID: 7877116
• DOI: 10.1016/0022-3956(94)90019-1

Abstract

The illicit use of anabolic steroids to enhance athletic performance and physical appearance can cause numerous psychiatric and other adverse effects. In order to prevent steroid use and its negative consequences, knowledge of risk factors is needed. We conducted an anonymous survey of 404 male weight lifters from community gymnasiums who completed a 20-min, self-administered questionnaire. The sample for this study included all 35 men who were thinking about using steroids ("high-risk" nonusers), 50 randomly selected nonusers who were not thinking about using steroids ("low-risk" nonusers) and all 49 steroid users. The three groups differed in age, training characteristics, other performance-enhancers tried, body image, acquaintance with steroid users, and perception of negative consequences. When groups were compared along a continuum from low risk to high risk and from high risk to actual use, we found increasing amounts of competitive bodybuilding, performance-enhancers tried, and steroid-using acquaintances. Groups did not differ in their use of addictive substances. Nearly three-fourths of the high-risk group felt "not big enough," compared to 21% of the low-risk group and 38% of the steroid users (p < .001). These data suggest that steroids do work to increase satisfaction with body size, and that dissatisfaction with body size may contribute to the risk of using steroids.

Risk Factors for Illicit Anabolic-Androgenic Steroid Use in Male Weightlifters: A Cross-Sectional Cohort Study / Harrison G. Pope, Jr., Gen Kanayama, James I. Hudson. - (Biological Psychiatry 71 (2012 3 (February); p. 254–261)

• PMID: 21839424
• PMCID: PMC3218214
• DOI: 10.1016/j.biopsych.2011.06.024

Background

Illicit anabolic-androgenic steroid (AAS) abuse, though an important public health problem, remains inadequately studied. Almost all AAS abusers are male and lift weights, but the risk factors for AAS use among male weightlifters remain poorly understood.

Methods
We recruited 233 experienced male weightlifters, of whom 102 (44%) reported lifetime AAS use, and assessed their childhood and adolescent attributes retrospectively using structured clinical interviews and computerized questionnaires. This “cross-sectional cohort” approach—a design that we have formally presented in the recent methodological literature— utilizes a study cohort, not selected for outcomes of interest, and assesses exposures and outcomes retrospectively. We hypothesized that conduct disorder and body-image concerns would be major risk factors for subsequent AAS use among male weightlifters.

Results
Within our study population, many attributes showed little association with AAS use, but conduct disorder and body-image concerns showed strong associations. For individuals with prior conduct disorder vs. those without, the hazard ratio [95% confidence interval] for subsequent AAS use was 2.2 [1.5, 3.4]. For individuals in the middle vs. lowest tertile of scores on a retrospective adolescent “muscle-dysmorphia” scale, the hazard ratio was 1.5 [0.84, 2.6]; for the highest vs. lowest tertile, the hazard ratio was 3.3 [2.0, 5.3]; and for the linear trend of hazard ratios, P < 0.001.

Conclusions
Conduct disorder and body-image concerns represent important risk factors for AAS use among male weightlifters. Thus, assessment of these attributes may help to identify individuals most likely to require interventions to discourage this form of substance abuse.

The phenomenon of prohibited substance use among athletes, intending to increase artificially their performance has its origins in the ancient times and it is now so present, as it is supported and fed by the professional sport, so much commercialized and mediated. In the current study, we take into account that according to the humanistic psychology, the individual is free to decide over his or her life, being capable to make decisions and to lead himself or herself. Although each individual is unique, he lives in a collectivity, which is on its turn unique. From the synthesis of the two systems results a specific behavior of the individual athlete, who lives the sport activities specific situations. The efforts of the militants for a clean sport which are now or efforts, must be based on a good knowledge of the personality traits of the athletes and the impact of the impact of the entourage over them. All educational activities aiming to reduce and finally eradicate doping in all sports should be developed on these bases.

The main conclusion of our research confirms in general the formulated hypothesis that the elements of the athletes’ personality structure and the social environment may represent risk factors for the doping behavior. The risk factors with important signification are the ones in the system of personality features, especially in the domain of attitudes, knowledge and moral beliefs, all of these related to the aspects specific to sport practice and entourage. The idea that the features of Type A of personality of Romanian athletes are part of the risk factors category is not confirmed well enough.